Inspection Report We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards. The Air Ambulance Service Fire & Rescue Building, Coventry Airport, Baginton, Coventry, CV8 3AZ Tel: 02476304832 Date of Inspection: 06 February 2014 Date of Publication: March 2014 We inspected the following standards as part of a routine inspection. This is what we found: Care and welfare of people who use services Cleanliness and infection control Supporting workers Records Inspection Report The Air Ambulance Service March 2014 www.cqc.org.uk 1
Details about this location Registered Provider Registered Manager Overview of the service Type of service Regulated activities The Air Ambulance Service Mr. Alex Toft Warwickshire and Northamptonshire Air Ambulance is a charitable organisation. It provides an emergency medical service, including emergency medical treatment and transport. The service is based at Coventry Airport, Baginton and provides Helicopter Emergency Medical Care (HEMS) for the Warwickshire, Northamptonshire and Milton Keynes area. Ambulance service Diagnostic and screening procedures Surgical procedures Transport services, triage and medical advice provided remotely Treatment of disease, disorder or injury Inspection Report The Air Ambulance Service March 2014 www.cqc.org.uk 2
Contents When you read this report, you may find it useful to read the sections towards the back called 'About CQC inspections' and 'How we define our judgements'. Summary of this inspection: Page Why we carried out this inspection 4 How we carried out this inspection 4 What people told us and what we found 4 More information about the provider 4 Our judgements for each standard inspected: Care and welfare of people who use services 5 Cleanliness and infection control 7 Supporting workers 9 Records 11 About CQC Inspections 12 How we define our judgements 13 Glossary of terms we use in this report 15 Contact us 17 Inspection Report The Air Ambulance Service March 2014 www.cqc.org.uk 3
Summary of this inspection Why we carried out this inspection This was a routine inspection to check that essential standards of quality and safety referred to on the front page were being met. We sometimes describe this as a scheduled inspection. This was an announced inspection. How we carried out this inspection We looked at the personal care or treatment records of people who use the service, carried out a visit on 6 February 2014 and talked with staff. What people told us and what we found When we visited the service we spoke with the manager who told us how the service operated. We were not able to speak with patients due to the nature of the service. Patients were able to comment on their experience of the service through various measures. For example, telephone, email and the hospital Patient Advice and Liaison Services (PALS). Thank you cards were displayed at the base from people who had used the service. We saw that infection control and prevention procedures were in place. Helicopters, equipment and staff facilities were cleaned in accordance with a detailed infection control policy and cleaning schedule. We found that staff felt well supported by the team and received training appropriate for their role. We reviewed patient care records and staff records and saw they were completed appropriately. We saw that there were systems in place for the regular audit of records. You can see our judgements on the front page of this report. More information about the provider Please see our website www.cqc.org.uk for more information, including our most recent judgements against the essential standards. You can contact us using the telephone number on the back of the report if you have additional questions. There is a glossary at the back of this report which has definitions for words and phrases we use in the report. Inspection Report The Air Ambulance Service March 2014 www.cqc.org.uk 4
Our judgements for each standard inspected Care and welfare of people who use services People should get safe and appropriate care that meets their needs and supports their rights Our judgement The provider was meeting this standard. Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. Reasons for our judgement The base had two helicopters, plus a response vehicle which did not carry patients. The manager told us that the service operated between different hours depending on seasonal conditions and how much daylight was available. Shifts were split between the Warwickshire and Northamptonshire air base and the air base at East Midlands Airport. This meant that one helicopter covered hours where the potential demand of the service was increased. For example, during the summer when daylight hours increase and helicopters can be used more. The manager told us that care and treatment was planned and delivered in a way that ensured the patient's safety and welfare. Staff told us that whenever possible they explained their actions to the patient, or parent /carer if present. This meant that care and treatment was developed with them or those acting on their behalf. Staff we spoke with demonstrated an understanding of the Mental Capacity Act 2005 and told us how they assessed capacity for consent. We spoke with a paramedic who told us that they carried out an assessment of each patient and provided emergency treatment based on that individual assessment. This meant that care was patient centred and considered their individual needs. Staff told us that the service had a variety of blankets to maintain people's privacy and dignity. We saw blankets were available when we inspected the helicopter. We looked at seven patient records and saw that they had been fully completed. Staff told us that the service used the same patient record forms as the local ambulance trust. They told us the forms were returned to the trust on completion and a copy was kept by the service. This meant that continuity in care, treatment and support could be maintained as a result of good communication between those who provide it. Inspection Report The Air Ambulance Service March 2014 www.cqc.org.uk 5
We saw equipment in the helicopter to aid diagnosis and emergency treatment. The manager told us that surgical and medical packs were checked at each shift to ensure that supplies were within their product date and securely sealed. The provider carried out regular audits to ensure that these checks were recorded. This meant care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. Inspection Report The Air Ambulance Service March 2014 www.cqc.org.uk 6
Cleanliness and infection control People should be cared for in a clean environment and protected from the risk of infection Our judgement The provider was meeting this standard. People were protected from the risk of infection because appropriate guidance had been followed. People were cared for in a clean, hygienic environment. Reasons for our judgement During our visit we saw infection control and prevention procedures were in place. We saw there was an infection control policy available for all staff to refer to. Staff we spoke with demonstrated an awareness of the policies and procedures and understood their responsibilities with regard to infection prevention and control. One member of staff had the designated role of infection control lead for the service. This meant that there was an accountable person who took responsibility for infection prevention and control. We saw that systems were in place to check the cleanliness of the helicopter, equipment and staff facilities. Records we looked at confirmed that routine cleaning was carried out. We found audits had been undertaken to ensure that the required checks and cleaning had been done. The manager told us that the helicopter was checked at the beginning of each day by the duty crew for cleanliness and any defects, such as frayed material or ripped seat covers. In addition contractors cleaned the helicopter internally daily and a deep clean was carried out weekly. We saw there was a cleaning schedule in place for the contractors to follow which was signed to confirm when the schedule had been completed. The manager told us that the helicopter was cleaned after each time it was used. Staff told us the decontamination and cleaning substances were available on the helicopter at all times. They told us this allowed them to respond to other calls without the need to return to base. We inspected the helicopter and saw it was clean and fit for purpose. The manager told us that clinical waste was disposed of by external contractors. We saw that there were written procedure for the disposal of clinical waste and soiled linen. This meant that there were effective systems in place to reduce the risk and spread of infection. We saw that monthly infection prevention and control audits of the helicopter were carried Inspection Report The Air Ambulance Service March 2014 www.cqc.org.uk 7
out. These included, for example, looking at the cleanliness of the helicopter. Any issues were identified and the actions taken were recorded on the audit form. We spoke with four paramedics and a pilot. Staff told us personal protective equipment (PPE), such as gloves were readily available at all times. They told us there was surplus PPE at the service base which could be used if their own became soiled or damaged during their shift. At the base we saw that there were shower facilities for helicopter personnel and a washing machine for cleaning uniforms. We were told that a cleaner was employed each day to maintain the cleanliness of the service base. This meant that staff worked in a clean, hygienic environment. Inspection Report The Air Ambulance Service March 2014 www.cqc.org.uk 8
Supporting workers Staff should be properly trained and supervised, and have the chance to develop and improve their skills Our judgement The provider was meeting this standard. People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. Reasons for our judgement We spoke with four paramedics and a pilot. Staff we spoke with told us that they provided support for each other. They told us that supervision was ongoing, particularly through the debriefing sessions and 'emergency of the day' training scenarios. Staff told us a debriefing session was held following each call out, which provided staff with support and allowed discussion regarding any issues arising from it. They told us they used challenging call outs as a training session and deconstructed the events to identify any lessons learnt. Staff told us a counsellor was available to support them following incidents they had attended. Staff told us that additional training was required to become a Helicopter Emergency Medical Service (HEMS) paramedic. We spoke with a recently appointment member of staff who was completing this training. They told us they had received all their personal protective equipment (PPE) and had a comprehensive introduction to the service on their first day. They told us they had been allocated a mentor who had supported them through their induction and they also felt supported by their team members. The new staff member told us that individual performance would be assessed to ensure they had the knowledge and skills to work competently within the service. This meant that people who used the service were cared for by staff that had the necessary training to care for them safely. The manager told us that an external training company had recently been contracted to provide annual mandatory training for staff and this had been completed. Staff files we looked at confirmed this. We found that staff who worked for other health services had received mandatory training there. They told us they had received annual appraisals at their other service which had taken into consideration feedback from the Warwickshire and Northamptonshire Air Ambulance Service. The manager told us that each staff member had a training file. We checked one of these files which supported the appraisal process and was fully completed. All staff had yearly supervision with the pilot and medical director to ensure they remained competent in their role. We saw the training records which were signed and completed to Inspection Report The Air Ambulance Service March 2014 www.cqc.org.uk 9
confirm this. We saw that there was a system in place to ensure that all staff were up to date with viewing policies, procedures and training requirements. Staff told us that monthly mortality and morbidity meeting minutes were emailed to the team. Staff we spoke with told us they were well informed regarding the service. They told us they were confident in their role and reported no concerns regarding training. Staff told us that if they requested extra training or training needs were identified as a result of a debriefing session, this would be sourced. This meant that staff received appropriate professional development. Inspection Report The Air Ambulance Service March 2014 www.cqc.org.uk 10
Records People's personal records, including medical records, should be accurate and kept safe and confidential Our judgement The provider was meeting this standard. People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained. Reasons for our judgement During our visit we saw that the service used both electronic and paper based record systems. We saw that paper records were all stored securely in lockable facilities. The electronic system used a password and backup facility to prevent any loss of data or unauthorised access of the network. This also meant that confidentiality was maintained, records were kept securely and could be located promptly when needed. We looked at seven patient's care and treatment records. We saw that they were fully completed, legible and clearly signed by the clinicians involved in the care. Staff explained how these were transferred to the ambulance service and that the ambulance service kept a copy. We saw that patient records were audited monthly to check they had been completed appropriately. Staff were made aware of the results and any issues were discussed. We saw that the results had improved when further audits had been undertaken. We looked at the electronic system which recorded all injuries, treatments, observations and medications administered as well dates and timings of call outs. This enabled the service to monitor the type of incidents they were attending and the injuries they were treating. This meant that the provider had records to inform the future planning of service delivery. Some records relating to staff such as training information were stored at the base. We saw one training file plus supervision training sheets which were signed and completed. The service had various checklists in place to check the safety and cleanliness of equipment. We saw that these had regularly been completed and were up to date. We saw certificates and documentation to support that medical equipment and the helicopter had been serviced. There was a system in place to identify equipment due for servicing. This meant that the provider kept appropriate records to support the management of equipment and helicopter. Inspection Report The Air Ambulance Service March 2014 www.cqc.org.uk 11
About CQC inspections We are the regulator of health and social care in England. All providers of regulated health and social care services have a legal responsibility to make sure they are meeting essential standards of quality and safety. These are the standards everyone should be able to expect when they receive care. The essential standards are described in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations 2009. We regulate against these standards, which we sometimes describe as "government standards". We carry out unannounced inspections of all care homes, acute hospitals and domiciliary care services in England at least once a year to judge whether or not the essential standards are being met. We carry out inspections of other services less often. All of our inspections are unannounced unless there is a good reason to let the provider know we are coming. There are 16 essential standards that relate most directly to the quality and safety of care and these are grouped into five key areas. When we inspect we could check all or part of any of the 16 standards at any time depending on the individual circumstances of the service. Because of this we often check different standards at different times. When we inspect, we always visit and we do things like observe how people are cared for, and we talk to people who use the service, to their carers and to staff. We also review information we have gathered about the provider, check the service's records and check whether the right systems and processes are in place. We focus on whether or not the provider is meeting the standards and we are guided by whether people are experiencing the outcomes they should be able to expect when the standards are being met. By outcomes we mean the impact care has on the health, safety and welfare of people who use the service, and the experience they have whilst receiving it. Our inspectors judge if any action is required by the provider of the service to improve the standard of care being provided. Where providers are non-compliant with the regulations, we take enforcement action against them. If we require a service to take action, or if we take enforcement action, we re-inspect it before its next routine inspection was due. This could mean we re-inspect a service several times in one year. We also might decide to reinspect a service if new concerns emerge about it before the next routine inspection. In between inspections we continually monitor information we have about providers. The information comes from the public, the provider, other organisations, and from care workers. You can tell us about your experience of this provider on our website. Inspection Report The Air Ambulance Service March 2014 www.cqc.org.uk 12
How we define our judgements The following pages show our findings and regulatory judgement for each essential standard or part of the standard that we inspected. Our judgements are based on the ongoing review and analysis of the information gathered by CQC about this provider and the evidence collected during this inspection. We reach one of the following judgements for each essential standard inspected. This means that the standard was being met in that the provider was compliant with the regulation. If we find that standards were met, we take no regulatory action but we may make comments that may be useful to the provider and to the public about minor improvements that could be made. Action needed This means that the standard was not being met in that the provider was non-compliant with the regulation. We may have set a compliance action requiring the provider to produce a report setting out how and by when changes will be made to make sure they comply with the standard. We monitor the implementation of action plans in these reports and, if necessary, take further action. We may have identified a breach of a regulation which is more serious, and we will make sure action is taken. We will report on this when it is complete. Enforcement action taken If the breach of the regulation was more serious, or there have been several or continual breaches, we have a range of actions we take using the criminal and/or civil procedures in the Health and Social Care Act 2008 and relevant regulations. These enforcement powers include issuing a warning notice; restricting or suspending the services a provider can offer, or the number of people it can care for; issuing fines and formal cautions; in extreme cases, cancelling a provider or managers registration or prosecuting a manager or provider. These enforcement powers are set out in law and mean that we can take swift, targeted action where services are failing people. Inspection Report The Air Ambulance Service March 2014 www.cqc.org.uk 13
How we define our judgements (continued) Where we find non-compliance with a regulation (or part of a regulation), we state which part of the regulation has been breached. Only where there is non compliance with one or more of Regulations 9-24 of the Regulated Activity Regulations, will our report include a judgement about the level of impact on people who use the service (and others, if appropriate to the regulation). This could be a minor, moderate or major impact. Minor impact - people who use the service experienced poor care that had an impact on their health, safety or welfare or there was a risk of this happening. The impact was not significant and the matter could be managed or resolved quickly. Moderate impact - people who use the service experienced poor care that had a significant effect on their health, safety or welfare or there was a risk of this happening. The matter may need to be resolved quickly. Major impact - people who use the service experienced poor care that had a serious current or long term impact on their health, safety and welfare, or there was a risk of this happening. The matter needs to be resolved quickly We decide the most appropriate action to take to ensure that the necessary changes are made. We always follow up to check whether action has been taken to meet the standards. Inspection Report The Air Ambulance Service March 2014 www.cqc.org.uk 14
Glossary of terms we use in this report Essential standard The essential standards of quality and safety are described in our Guidance about compliance: Essential standards of quality and safety. They consist of a significant number of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations 2009. These regulations describe the essential standards of quality and safety that people who use health and adult social care services have a right to expect. A full list of the standards can be found within the Guidance about compliance. The 16 essential standards are: Respecting and involving people who use services - Outcome 1 (Regulation 17) Consent to care and treatment - Outcome 2 (Regulation 18) Care and welfare of people who use services - Outcome 4 (Regulation 9) Meeting Nutritional Needs - Outcome 5 (Regulation 14) Cooperating with other providers - Outcome 6 (Regulation 24) Safeguarding people who use services from abuse - Outcome 7 (Regulation 11) Cleanliness and infection control - Outcome 8 (Regulation 12) Management of medicines - Outcome 9 (Regulation 13) Safety and suitability of premises - Outcome 10 (Regulation 15) Safety, availability and suitability of equipment - Outcome 11 (Regulation 16) Requirements relating to workers - Outcome 12 (Regulation 21) Staffing - Outcome 13 (Regulation 22) Supporting Staff - Outcome 14 (Regulation 23) Assessing and monitoring the quality of service provision - Outcome 16 (Regulation 10) Complaints - Outcome 17 (Regulation 19) Records - Outcome 21 (Regulation 20) Regulated activity These are prescribed activities related to care and treatment that require registration with CQC. These are set out in legislation, and reflect the services provided. Inspection Report The Air Ambulance Service March 2014 www.cqc.org.uk 15
Glossary of terms we use in this report (continued) (Registered) Provider There are several legal terms relating to the providers of services. These include registered person, service provider and registered manager. The term 'provider' means anyone with a legal responsibility for ensuring that the requirements of the law are carried out. On our website we often refer to providers as a 'service'. Regulations We regulate against the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations 2009. Responsive inspection This is carried out at any time in relation to identified concerns. Routine inspection This is planned and could occur at any time. We sometimes describe this as a scheduled inspection. Themed inspection This is targeted to look at specific standards, sectors or types of care. Inspection Report The Air Ambulance Service March 2014 www.cqc.org.uk 16
Contact us Phone: 03000 616161 Email: enquiries@cqc.org.uk Write to us at: Care Quality Commission Citygate Gallowgate Newcastle upon Tyne NE1 4PA Website: www.cqc.org.uk Copyright Copyright (2011) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Inspection Report The Air Ambulance Service March 2014 www.cqc.org.uk 17